输卵管积水性不孕症患者子宫内膜形态及容受性评估IVF-ET妊娠结局的临床研究

doi:10.11958/20220414

摘要/Abstract

摘要：

目的探究输卵管积水性不孕症患者动态子宫内膜形态及容受性在体外受精-胚胎移植（IVF-ET）妊娠结局中的评估作用。方法选取输卵管积水性不孕症患者99例，均行拮抗剂方案助孕，根据第一周期IVF-ET妊娠结局分为妊娠组（43例）和未妊娠组（56例），比较2组子宫内膜形态及血流动力学指数，同时采集取卵周期“着床窗”内膜活检标本，采用免疫组织化学染色检测同源框基因A10（HOXA10）和整合素家族（α_vβ3）表达。结果 2组患者子宫位置和子宫内膜形态情况比较差异无统计学意义（P>0.05）。COH周期启动日（D1）时，妊娠组子宫动脉PI低于未妊娠组;HCG注射日（D2）时，妊娠组子宫内膜厚度大于未妊娠组，子宫动脉PI和RI均低于未妊娠组（P<0.01）;妊娠组患者内膜组织中HOXA10和α_vβ3表达高于未妊娠组（P<0.05）。D2时子宫动脉RI、内膜组织HOXA10和α_vβ3表达是影响患者IVF-ET妊娠结局的独立因素（P<0.05）;内膜组织HOXA10和α_vβ3表达预测患者IVF-ET未妊娠有一定价值，曲线下面积分别为0.778（95%CI：0.681~0.874）和0.779（95%CI：0.685~0.873）。结论输卵管积水性不孕症患者子宫内膜容受性指标HOXA10和α_vβ3表达对其IVF-ET妊娠结局有积极的预测作用。

关键词: 体外受精, 胚胎移植, 妊娠结局, 输卵管积水性不孕症, 子宫内膜形态, 子宫内膜容受性

Abstract:

Objective To explore the evaluation of dynamic endometrial morphology and receptivity for pregnancy outcomes of in vitro fertilization-embryo transfer (IVF-ET) in patients with hydrosalpinx infertility. Methods A total of 99 patients with hydrosalpinx infertility were enrolled. All were given antagonist regimens for assisted reproduction. According to the first IVF-ET pregnancy outcomes, patients were divided into the pregnancy group (43 cases) and the non-pregnancy group (56 cases). The endometrial morphology and hemodynamic indexes were compared between the two groups. The specimens of endometrial biopsy in implantation window of oocyte retrieval period were collected to detect the expressions of homeobox gene A10 (HOXA10) and integrin α_vβ3 by immunohistochemical staining. Results There were no significant differences in uterine position and endometrial morphology between the two groups (P>0.05). On the start day of COH cycle (D1), uterine artery PI was lower in the pregnancy group than that in the non-pregnancy group. On the day of HCG injection (D2), endometrial thickness was greater in the pregnancy group than that in the non-pregnancy group, and uterine artery PI and RI were lower in the pregnancy group than those in the non-pregnancy group (P<0.01). The expression levels of HOXA10 and integrin α_vβ3 in endometrial tissue were significantly higher in the pregnancy group than those in the non-pregnancy group (P<0.05). On D2, the expression of RI in uterine artery, HOXA10 and integrin α_vβ3 in endometrial tissue were independent factors influencing pregnancy outcomes of IVF-ET (P<0.05). The expression levels of HOXA10 and integrin α_vβ3 in endometrial tissue were of certain predictive value for IVF-ET pregnancy, and the area under the curve (AUC) were 0.778 (95%CI: 0.681-0.874) and 0.779 (95%CI: 0.685-0.873), respectively. Conclusion The endometrial receptivity indexes HOXA10 and α_vβ3 have a positive predictive effect on pregnancy outcomes of IVF-ET in patients with hydrosalpinx infertility.

Key words: fertilization in vitro, embryo transfer, pregnancy outcome, hydrosalpinx infertility, endometrial morphology, endometrial receptivity

中图分类号:

R711.76

图/表 6

参考文献 19

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组别	n	年龄（岁）	不孕年限（年）	BMI （kg/m²）	基础窦卵泡数（个）	抗苗勒管激素（μg/L）	促卵泡激素（IU/L）	促黄体生成素（IU/L）	雌二醇（ng/L）	促性腺激素用量（U）
妊娠组	43	30.23±3.46	3.88±1.15	21.42±2.46	3.56±0.81	0.70±0.23	7.25±1.95	4.65±1.02	31.52±6.89	2 716.58±680.54
未妊娠组	56	30.92±3.38	4.12±1.28	22.26±2.65	3.39±0.92	0.64±0.21	6.52±2.10	4.51±1.18	33.67±7.24	2 721.32±711.47
t		1.100	0.966	1.612	0.959	1.352	1.768	0.620	1.495	0.033

组别	n	年龄（岁）	不孕年限（年）	BMI （kg/m²）	基础窦卵泡数（个）	抗苗勒管激素（μg/L）	促卵泡激素（IU/L）	促黄体生成素（IU/L）	雌二醇（ng/L）	促性腺激素用量（U）
妊娠组	43	30.23±3.46	3.88±1.15	21.42±2.46	3.56±0.81	0.70±0.23	7.25±1.95	4.65±1.02	31.52±6.89	2 716.58±680.54
未妊娠组	56	30.92±3.38	4.12±1.28	22.26±2.65	3.39±0.92	0.64±0.21	6.52±2.10	4.51±1.18	33.67±7.24	2 721.32±711.47
t		1.100	0.966	1.612	0.959	1.352	1.768	0.620	1.495	0.033

组别	n	子宫位置			子宫内膜形态
组别	n	前位	水平位	后位	A型	B型	C型
妊娠组	43	25（58.14）	9（20.93）	9（20.93）	23（53.49）	11（25.58）	9（20.93）
未妊娠组	56	39（69.64）	9（16.07）	8（14.29）	32（57.14）	15（26.79）	9（16.07）
χ²		1.439			0.388

组别	n	子宫位置			子宫内膜形态
组别	n	前位	水平位	后位	A型	B型	C型
妊娠组	43	25（58.14）	9（20.93）	9（20.93）	23（53.49）	11（25.58）	9（20.93）
未妊娠组	56	39（69.64）	9（16.07）	8（14.29）	32（57.14）	15（26.79）	9（16.07）
χ²		1.439			0.388

组别		n	子宫内膜厚度（mm）
组别		n	D1			D2
妊娠组		43	5.49±0.18			12.42±0.35
未妊娠组		56	5.42±0.22			11.06±0.29
t			1.695			21.134^＊＊
组别	子宫动脉PI				子宫动脉RI
组别	D1			D2	D1		D2
妊娠组	2.15±0.11			1.93±0.15	0.83±0.09		0.73±0.12
未妊娠组	2.37±0.21			2.24±0.19	0.86±0.13		0.82±0.15
t	6.239^＊＊			8.796^＊＊	1.293		3.221^＊＊